Mania and BPD

Question 1

Lifetime risk

Answer 1

1%

Question 2

M:F BPD

Answer 2

=

Question 3

Age of onset BPD

Answer 3

Generally late teenage –> early twenties

Question 4

Aetiology BPD (3)

Answer 4

Genetics (relatives)
Life events e.g prolonged stress/vulnerability factors
Substance misuse

Question 5

Average length manic ep

Answer 5

6 months

Question 6

After 1st manic episode, what % will have further mood disturbance

Answer 6

> 90%

Question 7

How many times more likely are pt w/ BPD to die by suicide than the general population

Answer 7

20-30x

Question 8

Causes of relapse BPD (6)

Answer 8

Non-concordance w/ meds
Life events, social stressors 
Disruption circadian rhythm 
Substance misuse
Childbirth 
Natural course illness

Question 9

Features of mood - BPD

Answer 9

Elevated/irritable

When elevated = high/on top of the world

Question 10

Biological features of BPD (2)

Answer 10

Decreased need for sleep

Increased energy

Question 11

Cognitive features of BPD (4)

Answer 11

Elevated sense self-esteem/grandiosity
Poor concentration
Accelerated thinking
Impaired judgement + insight

Question 12

Psychotic symptoms of BPD (3)

Answer 12

Disordered thought form; circumstantiality, tangentiality, flight of idas
Abnormal beliefs, often mood congruent
Perceptual disturbance (subtle distortions)

Question 13

Sx hypomania (7)

Answer 13

Mild elevation/instability in mood 
Increased energy 
Mild overspending/risk-taking 
Increased sociability, overfamiliarity
Distractibility 
Increased sexual energy 
Decreased need for sleep

Question 14

Sx Mania (8)

Answer 14

Mood elevated, expansive + irritable 
Increased activity
Reckless behaviour 
Disinhibition
Marked distractibility 
Marked increased sexual energy 
Sleep severely impaired /absent 
Grandiosity

Question 15

Def acute mania

Answer 15

1 ep of mania

Question 16

Def bipolar affective disorder

Answer 16

1 ep mania 1 ep depression

Question 17

What are the 3 degrees of severity of a manic episode?

Answer 17

Hypomania
Mania w/o psychotic Sx
Mania w/ psychotic Sx

Question 18

Cyclothymia

Answer 18

Persistent instability of mood w/ no periods of mild depression Sx or mild elation, where no ep meets the threshold for depressive or manic episode q

Question 19

Dysthymia

Answer 19

A mood that is chronically low, where no ep justifies a diagnosis of depressive disorder

Question 20

DOuble depression

Answer 20

Occurrence of an ep of depression in someone w/ a prev Hx of dysthymia

Question 21

Organic DDx BPD (4)

Answer 21

Substance misuse
Hyperthyroidism
Space occupying lesion (frontal)
Epilepsy

Question 22

Biological Mx - acute mania

Answer 22

1st line = antipsychotic e.g. haloperiol, risperidone, quetiapine
Consider Li/Valporate
Consider benzos
Stop any prescribed anti-D

Question 23

Psychological Mx - acute Mania

Answer 23

Psychoeducation

Question 24

Social Mx - acute mania

Answer 24

Consider inpt admission
Advise: do not make any serious decisions whilst unwell
Consider calming, low stimulus enviro
Advise to maintain relationships w/ carers

Question 25

Biological Mx - Bipolar depression

Answer 25

Consider mood stabiliser - Li/valporate/lamotrigine AntiD/SSRI Consider 2nd gen antiP

Question 26

Psychological Mx - Bipolar depression

Answer 26

Psychoeducation | CBT

Question 27

Social mx - bipolar depression

Answer 27

Support Carer support Work around social inclusion Consider inpt admission if risk indicates

Question 28

Psychical health monitoring in BPD

Answer 28

Healthy eating W+CV/metabolic indicators at least annually If on meds e.g. Li - specific levels req monitoring NB - advice on contraception

Question 29

Indication for mood stabilisers (3)

Answer 29

Prophylaxis BPD Tx acute mania/hypomania Augmentation for anti-D in Tx resistant depression

Question 30

Lithium - indications (5)

Answer 30

``` Acute mania/hypomania Prophylaxis in BPD Bipolar depression Tx resistant depression Adjuncts to antipsychotics (schizoaffective disorder/schizophrenia) ```

Question 31

Therapeutic range Lithium

Answer 31

0.4-1.2

Question 32

SE Lithium (9)

Answer 32

``` GI upset Fine tremor Polyuria Polydipsia Metallic taste mouth Thirst W gain Oedema Ppt skin problems e.g. Psoriasis ```

Question 33

Causes of Lithium toxicity

Answer 33

Low Na diet Dehydration Dx interactions (NSAIDS, ACEi, thiazide loop diuretics) Physical illness

Question 34

Sx toxicity Lithium >1.5mmol/L (6)

Answer 34

``` Diarrhoea N+V Course tremor Ataxia Mm weakness ```

Question 35

Sx Lithium toxicity >2.0mmol/L (5)

Answer 35

``` Dysarthria Nystagmus Confusion Convulsions Coma ```

Question 36

Most common cardiac defect caused by lithium

Answer 36

Ebsteins anomaly

Question 37

Ix needed prior to commencing Lithium (5)

Answer 37

``` FBC Renal fct U+E TFT Pregnancy test ECG ```

Question 38

Indications - Valporate (2)

Answer 38

Acute manio/hypomania | Prophylaxis in BPD

Question 39

Mechanism of action Valporate

Answer 39

Inhibits catabolism of GABA, altering synaptic plasticity

Question 40

SE valporate (7)

Answer 40

``` Increased appetite + W gain Sedation Dizziness N+V Tremor Haematolgical abnormalities ```

Question 41

Indications - lamotrigine (3)

Answer 41

BPD Prophylaxis in BPD ? Augmentation of antiD's in Tx resistant depression

Question 42

SE lamotrigine (4)

Answer 42

SJS N V Cleft lip/palate risk 1st trimester exposure

Question 43

Mode of action carbamazepine

Answer 43

Blocks voltage depedent Na channels

Question 44

Indications Carbamazepine

Answer 44

Acute mania/hypomania Prophyalxis BPD? Bipolar depression